Penile Cancer


Rare in the United States. More common in less developed regions of the world (i.e. Asia, Africa, South America)

Risk Factors

Premalignant lesions, uncircumcised penis, nonretractile foreskin (i.e. phimosis), chronic penile contact with smegma (combination of desquamated epithelial cells and glandular secretions from preputial glands which is common underlying the foreskin), HPV viral infection, HIV viral infection, smoking, prior PUVA therapy (psoralen and ultraviolet A photochemotherapy), possibly race and family history.


  • Squamous Cell Carcinoma: >95%
  • Other: (rare) soft tissue sarcoma, urethral tumors, lymphomas, basal cell carcinoma, melanoma, metastatic disease.

Staging (TNM)

Primary Tumor (T):

  • TX-primary tumor cannot be assessed
  • T0-No evidence of primary tumor
  • Tis-Carcinoma in-situ
  • Ta-Non-invasive verrucous carcinoma
  • T1a-Tumor invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated (i.e. Not grade 3 or 4)
  • T1b-Tumor invades subepithelial connective tissue with lymphovascular invasion or is poorly differentiated (grade 3 or 4)
  • T2-Tumor in the corpus spongiosum or corpus cavernosum
  • T3-Tumor in the urethra
  • T4-Tumor in other adjacent organs

Regional Lymph Nodes (N):

  • cNx-Regional lymph nodes cannot be assessed
  • cN0-No palpable or visible enlarged inguinal lymph nodes
  • cN1-palpable mobile unilateral inguinal lymph nodes
  • cN2-palpable mobile, multiple or bilateral inguinal lymph nodes
  • cN3-palpable fixed inguinal nodal mass or pelvic lymphadenopathy unilateral or bilateral
  • pNx-regional lymph nodes cannot be assessed
  • pN0-No regional lymph node metastasis
  • pN1-Metastasis in a single inguinal lymph node
  • pN2-Metastasis in multiple or bilateral inguinal lymph nodes
  • pN3-Extranodal extension of lymph node metastasis or pelvic lymph node(s) unilateral or bilateral

Distant Metastasis (M):

  • M0-No distant metastasis
  • M1-Distant metastasis


  • Biopsy of the primary lesion
  • Possible urethroscopy (i.e. scoping of the urethra to evaluate for involvement
  • Physical examination of the inguinal lymph nodes
  • General labs
  • Imaging: CT, MRI

Treatment Options

  • Treatment depends upon the stage, location, and histology of the cancer
  • Local, non-invasive lesions typically can be managed with less invasive therapies such as laser, cryotherapy, photodynamic therapy, topical medications (i.e. imiquimod, 5-FU), local surgical resection, or Moh’s micrographic surgery.
  • Invasive lesions require more aggressive therapy possibly requiring partial or total penectomy depending on the location and stage of the lesion. Many of these patients may also require inguinal or pelvic lymph node dissection. However, some patients may benefit from less aggressive local therapy with lasers or even Moh’s micrographic surgery
  • Locally advanced lesions often times require more extensive surgical resection.
  • Neoadjuvant (i.e. treatment before surgery) and/or Adjuvant (i.e. treatment after surgery) chemotherapy may be used in various clinical situations
  • Metastatic disease is typically treated with chemotherapy
  • Radiation has been used for treating penile cancer with both external beam and radioactive seeds (i.e. brachytherapy). It is less commonly used as first line therapy, especially in higher stage disease.

Recommended Follow-up

Follow-up is required for all patients after treatment with physical examination and imaging.